Application value of prognostic nutritional index in postoperative complications of da Vinci robotic McKeown surgery for esophageal cancer_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIANG Qiuhao ^1,2,3,4 , MA Minjie ^2,3,4 , LIN Ruijiang ^2,3,4 , WANG Chenhan ^1,2,3,4 , HAN Zhiwei ^1,2,3,4 ,  HAN Biao ^2,3,4

1. The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, P. R. China;
2. Department of Thoracic Surgery, The First Hospital of Lanzhou University, Lanzhou, 730000, P. R. China;
3. Major in Research and Development and Application of Key Technologies in Thoracic Surgery Gansu International Science and Technology Cooperation Base, Lanzhou, 730000, P. R. China;
4. Gansu Provincial Medical Quality Control Center of Thoracic Surgery, Lanzhou, 730000, P. R. China;

Corresponding?author：

HAN Biao, Email: hanbiao66@163.com

Keywords：

Prognostic nutritional index; da Vinci robot; McKeown surgery for esophageal cancer; postoperative complications

DOI：

10.7507/1007-4848.202207077

Video：

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Objective To explore the application value of prognostic nutritional index (PNI) in the postoperative complications of McKeown surgery for da Vinci robotic esophageal cancer. Methods The clinical data of the patients who underwent da Vinci robotic McKeown surgery for esophageal cancer in the Department of Thoracic Surgery of the First Hospital of Lanzhou University from January 2019 to June 2022 were retrospectively collected. According to the receiver operating characteristic (ROC) curve, the optimal cut-off value of PNI for predicting postoperative complications was explored. The patients were divided into a high PNI group and a low PNI group according to the cut-off value, and the differences in basic characteristics, surgery-related indexes and postoperative complications between the two groups were analyzed. According to the occurrence of postoperative complications, the patients were divided into a non-complication group and a complication group. Univariate and multivariate analyses were used to explore the influence of relevant indicators on the occurrence of postoperative complications in da Vinci robotic McKeown surgery for esophageal cancer. Results Finally 120 patients were collected, including 95 males and 25 females, with an average age of 62.82 years. The preoperative hemoglobin content, preoperative blood lymphocyte count, preoperative serum albumin and preoperative blood total cholesterol in the high PNI group were higher than those in the low PNI group (P<0.05). There were statistical differences between the two groups in the incidences of postoperative overall complications, pulmonary infection, pleural effusion and poor incision healing (P<0.05). The relevant indicators that may cause postoperative complications were included in univariate analysis, and the results showed that age, operation time, intraoperative blood loss, preoperative blood lymphocyte count, preoperative hemoglobin content, preoperative blood mononuclear cell count, preoperative blood monocyte count, serum albumin level and PNI were possible influencing factors of postoperative complications after da Vinci robotic McKeown surgery for esophageal cancer. Incorporating these influencing factors into multivariate analysis, the results showed that age, PNI, operation time and intraoperative blood loss were independent influencing factors of postoperative complications. Conclusion PNI has certain predictive value in the postoperative complications of da Vinci robotic McKeown surgery for esophageal cancer. PNI is an independent factor affecting postoperative complications. Improving the level of PNI in esophageal cancer patient before surgery may help reduce the occurrence of postoperative complications.

Citation： LIANG Qiuhao, MA Minjie, LIN Ruijiang, WANG Chenhan, HAN Zhiwei, HAN Biao. Application value of prognostic nutritional index in postoperative complications of da Vinci robotic McKeown surgery for esophageal cancer. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(3): 376-384. doi: 10.7507/1007-4848.202207077 Copy

1.	Pennathur A, Gibson MK, Jobe BA, et al. Oesophageal carcinoma. Lancet, 2013, 381(9864): 400-412.
2.	Kitagawa Y, Uno T, Oyama T, et al. Esophageal cancer practice guidelines 2017 edited by the Japan Esophageal Society: Part 1. Esophagus, 2019, 16(1): 1-24.
3.	Kitagawa Y, Uno T, Oyama T, et al. Esophageal cancer practice guidelines 2017 edited by the Japan Esophageal Society: Part 2. Esophagus, 2019, 16(1): 25-43.
4.	Haneda R, Hiramatsu Y, Kawata S, et al. Survival impact of perioperative changes in prognostic nutritional index levels after esophagectomy. Esophagus, 2022, 19(2): 250-259.
5.	Booka E, Takeuchi H, Suda K, et al. Meta-analysis of the impact of postoperative complications on survival after oesophagectomy for cancer. BJS Open, 2018, 2(5): 276-284.
6.	Angehrn FV, Neuschütz KJ, Fourie L, et al. From open Ivor Lewis esophagectomy to a hybrid robotic-assisted thoracoscopic approach: A single-center experience over two decades. Langenbecks Arch Surg, 2022, 407(4): 1421-1430.
7.	van Boxel GI, Kingma BF, Voskens FJ, et al. Robotic-assisted minimally invasive esophagectomy: Past, present and future. J Thorac Dis, 2020, 12(2): 54-62.
8.	Huang Y, Zhao YL, Song JD. Early outcomes with robot-assisted vs. minimally invasive esophagectomy for esophageal cancer: A systematic review and meta-analysis of matched studies. Eur Rev Med Pharmacol Sci, 2021, 25(24): 7887-7897.
9.	Xue Y, Zhou X, Xue L, et al. The role of pretreatment prognostic nutritional index in esophageal cancer: A meta-analysis. J Cell Physiol, 2019, 234(11): 19655-19662.
10.	Wang R, Cai H, Li Y, et al. Impact exerted by nutritional risk screening on clinical outcome of patients with esophageal cancer. Biomed Res Int, 2018, 2018: 7894084.
11.	周紅, 謝欽, 鄧明珍, 等. 預后營養指數和患者主觀整體評估對食管癌患者圍手術期營養預測的比較研究. 中國胸心血管外科臨床雜志, 2020, 27(4): 436-440.
12.	喻瑩, 石林林, 李佳怡, 等. 營養、免疫與食管癌患者的生存和預后研究進展. 食管疾病, 2022, 4(1): 64-69.
13.	Mirili C, Y?lmaz A, Demirkan S, et al. Clinical significance of prognostic nutritional index (PNI) in malignant melanoma. Int J Clin Oncol, 2019, 24(10): 1301-1310.
14.	Cadwell JB, Afonso AM, Shahrokni A. Prognostic nutritional index (PNI), independent of frailty is associated with six-month postoperative mortality. J Geriatr Oncol, 2020, 11(5): 880-884.
15.	Xiao FK, Wang L, Zhang WC, et al. Preoperative prognostic nutritional index is a significant predictor of survival in esophageal squamous cell carcinoma patients. Nutr Cancer, 2021, 73(2): 215-220.
16.	Liao G, Zhao Z, Yang H, et al. Can prognostic nutritional index be a prediction factor in esophageal cancer?: A meta-analysis. Nutr Cancer, 2020, 72(2): 187-193.
17.	Low DE, Alderson D, Cecconello I, et al. International consensus on standardization of data collection for complications associated with esophagectomy: Esophagectomy Complications Consensus Group (ECCG). Ann Surg, 2015, 262(2): 286-294.
18.	Moreno AC, Verma V, Hofstetter WL, et al. Patterns of care and treatment outcomes of elderly patients with stage Ⅰ esophageal cancer: Analysis of the National Cancer Data Base. J Thorac Oncol, 2017, 12(7): 1152-1160.
19.	Rustgi AK, El-Serag HB. Esophageal carcinoma. N Engl J Med, 2014, 371(26): 2499-2509.
20.	Huddy JR, Huddy FMS, Markar SR, et al. Nutritional optimization during neoadjuvant therapy prior to surgical resection of esophageal cancer: A narrative review. Dis Esophagus, 2018, 31(1): 1-11.
21.	Okadome K, Baba Y, Yagi T, et al. Prognostic nutritional index, tumor-infiltrating lymphocytes, and prognosis in patients with esophageal cancer. Ann Surg, 2020, 271(4): 693-700.
22.	A-Lai GH, Deng HY, Song TN, et al. Preoperative prognostic nutritional index shows no significant prognostic value for short-term outcomes of anastomosis-leakage patients after cancerous esophagectomy. Ann Palliat Med, 2019, 8(5): 698-707.
23.	Wang PY, Chen XK, Liu Q, et al. Application of four nutritional risk indexes in perioperative management for esophageal cancer patients. J Cancer Res Clin Oncol, 2021, 147(10): 3099-3111.
24.	Hirahara N, Tajima Y, Fujii Y, et al. Preoperative prognostic nutritional index predicts long-term surgical outcomes in patients with esophageal squamous cell carcinoma. World J Surg, 2018, 42(7): 2199-2208.
25.	Zhang H, Shang X, Ren P, et al. The predictive value of a preoperative systemic immune-inflammation index and prognostic nutritional index in patients with esophageal squamous cell carcinoma. J Cell Physiol, 2019, 234(2): 1794-1802.
26.	Nakatani M, Migita K, Matsumoto S, et al. Prognostic significance of the prognostic nutritional index in patients with recurrent esophageal squamous cell carcinoma. Nutr Cancer, 2018, 70(3): 467-473.
27.	Xu S, Cao S, Geng J, et al. High prognostic nutritional index (PNI) as a positive prognostic indicator for non-small cell lung cancer patients with bone metastasis. Clin Respir J, 2021, 15(2): 225-231.
28.	Hanada M, Hotta K, Matsuyama Y. Prognostic nutritional index as a risk factor for aseptic wound complications after total knee arthroplasty. J Orthop Sci, 2021, 26(5): 827-830.
29.	王通, 劉博, 滕洪, 等. 預后營養指數與食管鱗癌臨床病理特征相關性分析及其對術后并發癥預測價值. 臨床軍醫雜志, 2022, 50(3): 270-273.
30.	Qi Q, Song Q, Cheng Y, et al. Prognostic significance of preoperative prognostic nutritional index for overall survival and postoperative complications in esophageal cancer patients. Cancer Manag Res, 2021, 13: 8585-8597.
31.	王艷莉, 周秀耕, 馮曄, 等. 食管癌術后感染性并發癥的影響因素分析. 腸外與腸內營養, 2021, 28(5): 291-295.
32.	Xi X, Yang MX, Wang XY, et al. Predictive value of prognostic nutritional index on infection after radical gastrectomy: A retrospective study. J Gastrointest Oncol, 2022, 13(2): 569-580.
33.	韋斌, 鐘曉剛, 麥威, 等. 術前預后營養指數、炎癥標志物與結直腸癌患者預后及術后并發癥的關系研究. 現代生物醫學進展, 2022, 22(4): 746-751.
34.	Yoon JP, Nam JS, Abidin MFBZ, et al. Comparison of preoperative nutritional indexes for outcomes after primary esophageal surgery for esophageal squamous cell carcinoma. Nutrients, 2021, 13(11): 4086.
35.	郭孟剛, 周海寧, 楊緒全. 預后營養指數評估食管癌病人術后并發癥及預后的臨床價值. 安徽醫藥, 2021, 25(5): 898-902.
36.	Zhao X, Liu J, Wang Y, et al. Preoperative nutritional status and risk factors associated with delayed discharge in geriatric patients undergoing gastrectomy: A single-center retrospective study. Appl Bionics Biomech, 2022, 2022: 8263986.
37.	Hashimoto S, Araki M, Sumida Y, et al. Short- and long-term outcome after gastric cancer resection in patients aged 80 years and older. Cancer Diagn Progn, 2022, 2(2): 201-209.
38.	朱濤, 王偉. 預后營養指數對腹腔鏡直腸癌根治術后并發癥的預測價值. 現代腫瘤醫學, 2021, 29(24): 4353-4356.
39.	王青亮. 食管癌根治術后頸部吻合口瘺發生的影響因素分析. 淮海醫藥, 2020, 38(3): 287-289.
40.	Lin MY, Liu WY, Tolan AM, et al. Preoperative serum albumin but not prealbumin is an excellent predictor of postoperative complications and mortality in patients with gastrointestinal cancer. Am Surg, 2011, 77(10): 1286-1289.
41.	郭小榮, 郭成龍, 崔巧梅, 等. 預后營養指數對老年骨質疏松癥患者髖關節置換術后風險預測及影響因素分析. 中國骨質疏松雜志, 2020, 26(7): 967-971.
42.	Zhang H, Tao Y, Wang Z, et al. Evaluation of nutritional status and prognostic impact assessed by the prognostic nutritional index in children with chronic kidney disease. Medicine (Baltimore), 2019, 98(34): e16713.
43.	Sato R, Oikawa M, Kakita T, et al. The prognostic value of the prognostic nutritional index and inflammation-based markers in obstructive colorectal cancer. Surg Today, 2020, 50(10): 1272-1281.
44.	Mao YS, Hao SJ, Zou CF, et al. Controlling Nutritional Status score is superior to Prognostic Nutritional Index score in predicting survival and complications in pancreatic ductal adenocarcinoma: A Chinese propensity score matching study. Br J Nutr, 2020, 124(11): 1190-1197.

1. Pennathur A, Gibson MK, Jobe BA, et al. Oesophageal carcinoma. Lancet, 2013, 381(9864): 400-412.
2. Kitagawa Y, Uno T, Oyama T, et al. Esophageal cancer practice guidelines 2017 edited by the Japan Esophageal Society: Part 1. Esophagus, 2019, 16(1): 1-24.
3. Kitagawa Y, Uno T, Oyama T, et al. Esophageal cancer practice guidelines 2017 edited by the Japan Esophageal Society: Part 2. Esophagus, 2019, 16(1): 25-43.
4. Haneda R, Hiramatsu Y, Kawata S, et al. Survival impact of perioperative changes in prognostic nutritional index levels after esophagectomy. Esophagus, 2022, 19(2): 250-259.
5. Booka E, Takeuchi H, Suda K, et al. Meta-analysis of the impact of postoperative complications on survival after oesophagectomy for cancer. BJS Open, 2018, 2(5): 276-284.
6. Angehrn FV, Neuschütz KJ, Fourie L, et al. From open Ivor Lewis esophagectomy to a hybrid robotic-assisted thoracoscopic approach: A single-center experience over two decades. Langenbecks Arch Surg, 2022, 407(4): 1421-1430.
7. van Boxel GI, Kingma BF, Voskens FJ, et al. Robotic-assisted minimally invasive esophagectomy: Past, present and future. J Thorac Dis, 2020, 12(2): 54-62.
8. Huang Y, Zhao YL, Song JD. Early outcomes with robot-assisted vs. minimally invasive esophagectomy for esophageal cancer: A systematic review and meta-analysis of matched studies. Eur Rev Med Pharmacol Sci, 2021, 25(24): 7887-7897.
9. Xue Y, Zhou X, Xue L, et al. The role of pretreatment prognostic nutritional index in esophageal cancer: A meta-analysis. J Cell Physiol, 2019, 234(11): 19655-19662.
10. Wang R, Cai H, Li Y, et al. Impact exerted by nutritional risk screening on clinical outcome of patients with esophageal cancer. Biomed Res Int, 2018, 2018: 7894084.
11. 周紅, 謝欽, 鄧明珍, 等. 預后營養指數和患者主觀整體評估對食管癌患者圍手術期營養預測的比較研究. 中國胸心血管外科臨床雜志, 2020, 27(4): 436-440.
12. 喻瑩, 石林林, 李佳怡, 等. 營養、免疫與食管癌患者的生存和預后研究進展. 食管疾病, 2022, 4(1): 64-69.
13. Mirili C, Y?lmaz A, Demirkan S, et al. Clinical significance of prognostic nutritional index (PNI) in malignant melanoma. Int J Clin Oncol, 2019, 24(10): 1301-1310.
14. Cadwell JB, Afonso AM, Shahrokni A. Prognostic nutritional index (PNI), independent of frailty is associated with six-month postoperative mortality. J Geriatr Oncol, 2020, 11(5): 880-884.
15. Xiao FK, Wang L, Zhang WC, et al. Preoperative prognostic nutritional index is a significant predictor of survival in esophageal squamous cell carcinoma patients. Nutr Cancer, 2021, 73(2): 215-220.
16. Liao G, Zhao Z, Yang H, et al. Can prognostic nutritional index be a prediction factor in esophageal cancer?: A meta-analysis. Nutr Cancer, 2020, 72(2): 187-193.
17. Low DE, Alderson D, Cecconello I, et al. International consensus on standardization of data collection for complications associated with esophagectomy: Esophagectomy Complications Consensus Group (ECCG). Ann Surg, 2015, 262(2): 286-294.
18. Moreno AC, Verma V, Hofstetter WL, et al. Patterns of care and treatment outcomes of elderly patients with stage Ⅰ esophageal cancer: Analysis of the National Cancer Data Base. J Thorac Oncol, 2017, 12(7): 1152-1160.
19. Rustgi AK, El-Serag HB. Esophageal carcinoma. N Engl J Med, 2014, 371(26): 2499-2509.
20. Huddy JR, Huddy FMS, Markar SR, et al. Nutritional optimization during neoadjuvant therapy prior to surgical resection of esophageal cancer: A narrative review. Dis Esophagus, 2018, 31(1): 1-11.
21. Okadome K, Baba Y, Yagi T, et al. Prognostic nutritional index, tumor-infiltrating lymphocytes, and prognosis in patients with esophageal cancer. Ann Surg, 2020, 271(4): 693-700.
22. A-Lai GH, Deng HY, Song TN, et al. Preoperative prognostic nutritional index shows no significant prognostic value for short-term outcomes of anastomosis-leakage patients after cancerous esophagectomy. Ann Palliat Med, 2019, 8(5): 698-707.
23. Wang PY, Chen XK, Liu Q, et al. Application of four nutritional risk indexes in perioperative management for esophageal cancer patients. J Cancer Res Clin Oncol, 2021, 147(10): 3099-3111.
24. Hirahara N, Tajima Y, Fujii Y, et al. Preoperative prognostic nutritional index predicts long-term surgical outcomes in patients with esophageal squamous cell carcinoma. World J Surg, 2018, 42(7): 2199-2208.
25. Zhang H, Shang X, Ren P, et al. The predictive value of a preoperative systemic immune-inflammation index and prognostic nutritional index in patients with esophageal squamous cell carcinoma. J Cell Physiol, 2019, 234(2): 1794-1802.
26. Nakatani M, Migita K, Matsumoto S, et al. Prognostic significance of the prognostic nutritional index in patients with recurrent esophageal squamous cell carcinoma. Nutr Cancer, 2018, 70(3): 467-473.
27. Xu S, Cao S, Geng J, et al. High prognostic nutritional index (PNI) as a positive prognostic indicator for non-small cell lung cancer patients with bone metastasis. Clin Respir J, 2021, 15(2): 225-231.
28. Hanada M, Hotta K, Matsuyama Y. Prognostic nutritional index as a risk factor for aseptic wound complications after total knee arthroplasty. J Orthop Sci, 2021, 26(5): 827-830.
29. 王通, 劉博, 滕洪, 等. 預后營養指數與食管鱗癌臨床病理特征相關性分析及其對術后并發癥預測價值. 臨床軍醫雜志, 2022, 50(3): 270-273.
30. Qi Q, Song Q, Cheng Y, et al. Prognostic significance of preoperative prognostic nutritional index for overall survival and postoperative complications in esophageal cancer patients. Cancer Manag Res, 2021, 13: 8585-8597.
31. 王艷莉, 周秀耕, 馮曄, 等. 食管癌術后感染性并發癥的影響因素分析. 腸外與腸內營養, 2021, 28(5): 291-295.
32. Xi X, Yang MX, Wang XY, et al. Predictive value of prognostic nutritional index on infection after radical gastrectomy: A retrospective study. J Gastrointest Oncol, 2022, 13(2): 569-580.
33. 韋斌, 鐘曉剛, 麥威, 等. 術前預后營養指數、炎癥標志物與結直腸癌患者預后及術后并發癥的關系研究. 現代生物醫學進展, 2022, 22(4): 746-751.
34. Yoon JP, Nam JS, Abidin MFBZ, et al. Comparison of preoperative nutritional indexes for outcomes after primary esophageal surgery for esophageal squamous cell carcinoma. Nutrients, 2021, 13(11): 4086.
35. 郭孟剛, 周海寧, 楊緒全. 預后營養指數評估食管癌病人術后并發癥及預后的臨床價值. 安徽醫藥, 2021, 25(5): 898-902.
36. Zhao X, Liu J, Wang Y, et al. Preoperative nutritional status and risk factors associated with delayed discharge in geriatric patients undergoing gastrectomy: A single-center retrospective study. Appl Bionics Biomech, 2022, 2022: 8263986.
37. Hashimoto S, Araki M, Sumida Y, et al. Short- and long-term outcome after gastric cancer resection in patients aged 80 years and older. Cancer Diagn Progn, 2022, 2(2): 201-209.
38. 朱濤, 王偉. 預后營養指數對腹腔鏡直腸癌根治術后并發癥的預測價值. 現代腫瘤醫學, 2021, 29(24): 4353-4356.
39. 王青亮. 食管癌根治術后頸部吻合口瘺發生的影響因素分析. 淮海醫藥, 2020, 38(3): 287-289.
40. Lin MY, Liu WY, Tolan AM, et al. Preoperative serum albumin but not prealbumin is an excellent predictor of postoperative complications and mortality in patients with gastrointestinal cancer. Am Surg, 2011, 77(10): 1286-1289.
41. 郭小榮, 郭成龍, 崔巧梅, 等. 預后營養指數對老年骨質疏松癥患者髖關節置換術后風險預測及影響因素分析. 中國骨質疏松雜志, 2020, 26(7): 967-971.
42. Zhang H, Tao Y, Wang Z, et al. Evaluation of nutritional status and prognostic impact assessed by the prognostic nutritional index in children with chronic kidney disease. Medicine (Baltimore), 2019, 98(34): e16713.
43. Sato R, Oikawa M, Kakita T, et al. The prognostic value of the prognostic nutritional index and inflammation-based markers in obstructive colorectal cancer. Surg Today, 2020, 50(10): 1272-1281.
44. Mao YS, Hao SJ, Zou CF, et al. Controlling Nutritional Status score is superior to Prognostic Nutritional Index score in predicting survival and complications in pancreatic ductal adenocarcinoma: A Chinese propensity score matching study. Br J Nutr, 2020, 124(11): 1190-1197.

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Application value of prognostic nutritional index in postoperative complications of da Vinci robotic McKeown surgery for esophageal cancer

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